[A case of cerebral gumma].

A case of cerebral gumma in the left trigonal region is reported. A 74-year-old man was admitted to our hospital on Apr. 23, 1985 with unsteady gait and memory disturbance. Neurological examination revealed slight disorientation, memory disturbance, right homonymous hemianopsia and right hemiparesis. Serological reaction for syphilis was strongly positive, and so was CSF. The CSF showed slight pleocytosis (8/3 lymphocytes) and increased protein content (130 mg/dl). DSA showed no hypervascularity nor tumor stain. Ga brain scan showed no abnormality. The CT scan revealed an irregular low density area near the left trigone with abnormal contrast enhancement. Because of the radiological findings a malignant lymphoma was diagnosed and biopsy was performed, however, histological investigation confirmed the diagnosis of cerebral gumma. The patient was treated with penicillin and reduction of the tumor size was observed on CT scan. Cerebral gumma has been reported only rarely during the last few decades, and there are only a few descriptions of the neuroradiological characteristics of this disease. An accurate diagnosis can be made only by taking into consideration the clinical findings and course, the serological results, and the effect of the antisyphilitic treatment. When dealing with CT imaging similar to an intracranial malignant lymphoma, syphilitic disease of the brain should be regarded as possibly being present.